Community-based newborn care (CBNC) is a strategy to reduce persistently high neonatal mortality through the Health Extension Program (HEP). It was found that supportive supervision visits were an effective intervention in improving the consistency of skill of neonatal sepsis management. The Last 10 Kilometers (L10K) project uses a community-based strategy to improve reproductive, maternal, newborn, and child health (RMNCH) care-seeking behavior and practices. The evidence-based practices from L10K informed strategies of the Federal Ministry of Health (FMOH) and have guided scale-up of programs region-wide and nationally. This poster was presented at the IHI Africa Forum on Quality and Safety in Healthcare in Durban, South Africa.

1. BACKGROUND
 Ethiopia has implemented Community
Based Newborn Care (CBNC) as one
strategy to reduce its persistently high
neonatal mortality through the Health
Extension Program (HEP)
 To maintain the quality of community-
based management of neonatal
sepsis the following strategies have been applied:
 Competency based training
 Prompt post training follow up
 Continued coaching through regular supportive supervision (SS),
and
 Woreda level performance Review and Clinical Mentoring
Meetings (PRCMM).
Effectiveness of Supportive Supervision Visits on the Consistency of Community-Based Neonatal
Sepsis Management Skills of Health Extension Workers in 269 Woredas of Ethiopia
Gizachew Tiruneh, Ali Karim, Bantalem Yihun, Bizuhan Birhanu, Agazi Ameha, Bereket Mathiwos,
Biruk Tessema, Abera Wanboru, and Wuleta Betemariam
METHODS
Setting and Study Design
 The study domain was 6,416 in
269 woredas of Amhara,
Oromia, Tigray and Southern,
Nations, Nationalities and
People’s (SNNP) regions.
 A longitudinal program
monitoring data captured
between January 2014 and June
2016 was used for this study.
 A total of 8,006 SS visits to the
health posts were analysed
during the 30 month review
period.
Study Variables
 The outcome variable was the consistency of skills of HEWs in
neonatal sepsis management.
 The consistency of sepsis management was defined as
consistency in the recorded classification, treatment including
correct dose, duration and frequency, and follow up for neonatal
sepsis according to the national CBNC protocol.
 A health post was considered to provide consistent case
management for sepsis if 100% of the cases assessed were
consistently classified, treated and followed-up within two days of
initiating treatment.
 The independent variables were region, implementing partner,
observation period, frequency of SS and PRCMM.
Data Analysis
 Data was analysed using Stata v14.2
 To assess the effect of woreda meetings on the effect of
consistency of sepsis management skills of HEWs, the PRCMM
meetings database for each of the woredas was combined with the
SS database.
 The health post level repeated measures were accounted using
random effects multiple logistic regressions models.
Limitation of the Study
 The effect estimates observed could be confounded by
unmeasured variables and the presence of possible selection bias.
 Moreover, of the 6,416 health posts visited, only 942 health posts
that managed sepsis cases were used for the study which is not
randomly selected. This affects the representativeness of the study
samples and generalizability of the study results to other settings
and other samples.
 Health posts’ participation rate in the woreda-level review meetings
were small; as a consequence, this does not have the statistical
power to detect the effect of PRCMM on the consistency of case
management skills of HEWs.
OBJECTIVE OF THE STUDY
To examine the effects of the supportive supervision on the consistency of
neonatal sepsis management skill of health extension workers (HEWs)
Figure 1: study areas
RESULTS
Distribution of the SS visits at 6,416 health posts
Figure 2: Distribution of supportive supervision visits over observation period
Table 1: Trend in consistency of neonatal sepsis management skills over observation
quarters and frequency of supportive visits
Effects of SS on the consistency of neonatal sepsis management skills of HEWs
Table 2: Random effects logistic regression model estimates of the predictors of
consistency of neonatal sepsis management
Year Quarter
1st visit 2nd visit 3rd visit
% consistent # of cases % consistent # of cases % consistent # of cases
2014 Apr-Jun 78.8 52 87.5 8 0.0 0
Jul-Sep 88.9 36 00.0 6 0.0 0
Oct-Dec 92.0 50 91.9 37 0.0 0
2015 Jan-Mar 53.8 13 78.6 14 0.0 0
Apr-Jun 76.1 109 85.0 40 91.7 12
Jul-Sep 77.2 206 79.4 63 90.9 22
Oct-Dec 58.8 323 40.0 5 66.7 3
2016 Jan-Mar 74.5 106 65.4 52 84.8 33
Apr-Jun 64.1 39 65.3 72 76.5 17
Total 70.8 942 75.8 297 84.1 87
OR Std. Err. Z P-value 95% CI
Region
Amhara 1.00
Oromia 2.70 0.73 3.66 <0.001 1.59-4.60
SNNP 1.68 0.44 1.99 0.046 1.01-2.81
Tigray 2.33 2.01 0.98 0.328 0.43-12.64
# SS visit
1 1.00
2 1.32 0.29 1.26 0.208 0.86-2.02
3 2.49 0.99 2.33 0.020 1.16-5.38
# of PRCMM
0 1.00
1 1.25 0.28 0.99 0.324 0.80-1.95
2 1.95 1.01 1.29 0.198 0.71-5.36
IP
SCI 1.00
L10K 1.01 0.26 0.03 0.975 0.61-1.68
CONCLUSIONS AND RECOMMENDATIONS
 The findings of this study suggest that SS visits were an effective intervention in
improving the consistency of skills of neonatal sepsis management.
 At least three rounds of supervision are needed to ensure optimum skills of
neonatal sepsis management at the community level.
 In the Ethiopia context, policymakers and program planners should make
additional investments to sustain the effort of SS of the health extension program
including recent initiatives such as iCCM and CBNC.
 A qualitative research is recommended to explore the nature of SS that results in
high performance and motivation of HEWs.
 We also recommended continuing to track this type of data to observe the effects
of SS and PRCMMs on the quality of care as part of improving program
implementation.
JSI Research and Training Institute Inc., L10K Project, P.O. Box 13898, Addis Ababa, Ethiopia Tel: +251-11-6620066, Fax: +251-11-6630919,
AFRICA FORUM ON QUALITY AND SAFETY IN HEALTH CARE
February 19-21, 2018 | Durban, South Africa